Misunderstood, Misdiagnosed and Often

News to enrich your lifestyle
Spring 2015
Misunderstood, Misdiagnosed and Often Mistreated:
Solving the Puzzle of Lyme Disease
Unsurprisingly for an illness known as “The Great
Imitator,” the misconceptions surrounding Lyme
Disease continue to proliferate. Acute or chronic?
Highly treatable or stubbornly resistant? Misdiagnosed because of symptoms that mimic conditions
like lupus, multiple sclerosis, Parkinson’s and Lou
Gehrig’s disease, or overestimated for the same
reason? While television celebrity Yolanda Foster
recently gained national attention during her bout
with chronic Lyme disease, she also fanned the
flames of controversy surrounding this sometimes
mystifying condition. A brief overview of current
knowledge follows…however experts have not yet
reached a consensus on all aspects of this disease.
Research indicates that Lyme disease is transmitted
to humans by a bite from a tick infected by the spirochete bacteria, primarily found on the East Coast and
in the Midwest. Carried by deer and migratory birds,
Lyme disease is on the rise, estimated at 300,000
cases annually in America, considerably larger than
the 30,000 cases earlier reported by the Centers for
Disease Control (CDC).
The distinctive bull’s eye rash is one identifiable
marker of the disease, seen in 70 percent of patients.
In the early stages, fatigue and flu-like aches and
pains are typical; in later stages, nerve numbness
or pain, facial paralysis or weakness, and heart
problems are seen; and if not treated, serious and
long-term complications that affect the brain, joints,
nerves, heart and muscles can occur, according to
the Lyme Research Alliance.
damage to tissue and the immune system. Still others,
including Dr. Allen Steere, who first recognized Lyme
disease back in 1975, say it is being over-diagnosed,
mistaken for chronic fatigue or chronic pain.
The continued questioning spurred John Aucott, MD,
assistant professor of rheumatology at Johns Hopkins
University School of Medicine and founder of the
Lyme Disease Research Foundation, to launch the
nation’s first controlled study examining long-term
health and outcomes of the disease.
Lab tests are generally needed
to confirm the diagnosis, followed by a course of
oral antibiotics. However, people with early Lyme
disease do not develop antibodies for several
weeks, resulting in frequent false negatives on the
commonly used ELISA or Western Blot antibody
tests. For that reason, treating patients based
solely on clinical findings, such as a rash and known
exposure to ticks, is recommended by some experts,
while others advise more aggressive, longer and
individualized treatment. All agree, however, that
earlier treatment is more effective.
About 20 percent of patients with Lyme disease
continue to experience symptoms months and years
after treatment ends…and this is where the real
debate begins. Muscle and joint pain, cardiac and
neurological problems and fatigue have been reported
by those with chronic Lyme disease. Some experts
believe it indicates an ongoing bacterial infection,
while others attribute lingering symptoms to residual
From the desk of Marc Spero, MD
Dear Patient:
Welcome to spring, the best time to start relishing the pleasures of longer, sunnier days
outside…but not without a good night’s sleep. Research shows one third of American
adults struggle with restless nights and drowsy days, and we are all logging two fewer
hours each night than our ancestors. We’ll explain why the restorative power of sleep
is essential at every age and share tips to ensure a restful night.
We also take a timely look at Lyme disease, which is seen most frequently during this season when ticks, which
carry the bacterium, are prevalent. The condition is often misdiagnosed and the best treatment is still a
matter of much debate among physicians…all of which makes prevention essential. You’ll find information in
this issue of HealthWise on how to spot the symptoms, current approaches to treatment, and most important,
how to avoid tick bites while enjoying walks in the great outdoors.
Finally, we hope you will try our quick guide to ordering the healthiest options when dining out at your favorite
ethnic restaurant. Whether you’re seeking new tastes, or prefer tried-and-true dishes, we’ll help you make
the right choices. Bon appetit!
Wishing you good health,
Marc Spero, MD
“It does no good to keep debating the existence of
long-term problems related to Lyme disease while
people are suffering a debilitating illness. These
patients are lost. No one really knows what to do with
them. It’s a challenge, but the first thing we need to
do is recognize this is a problem,” he said.
The headwinds have been strong. Lyme disease ranks
well below breast cancer and HIV/AIDS for federal
funding, despite a significantly higher rate of cases,
according to lymedisease.org, but Aucott’s study
and others represent hopeful progress.
In the meantime, decrease your risk of contracting
Lyme disease by wearing shoes, long pants tucked
into your socks, a long-sleeved shirt, hat and gloves
when walking in woodsy areas; sticking to trails and
avoiding low bushes and long grass; and using insect
repellents with a 20 percent or higher concentration
of DEET. If you are bitten by a tick, call my office
promptly, but do not panic…your chances of acquiring
Lyme disease are no more than 1.4 percent.
Marc Spero, MD
110 E. 55th Street
17th Floor
New York, NY 10022
Office: 212.355.8315
Fax: 212.355.9741
Email: [email protected]
www.marcsperomd.com
Recognized by Castle Connolly
Top Doctors
Internal Medicine
1994-2012
Eyes Wide Shut: Why Eight Hours of Sleep is a Prescription for Better Health
In today’s time-pressed world, a full night’s sleep has
become akin to a luxury, but beware: it is a vital
necessity. Lack of sleep affects your health, from stress
to heart disease to overall well-being. Even an occasional all-nighter impedes our ability to concentrate,
analyze information, and significantly, to drive, making
sleepiness at the wheel the cause of over 100,000
car accidents each year.
Call it a by-product of our increasingly hectic lifestyle:
we now sleep two hours less nightly than our ancestors, and in just the last decade, another 38 minutes
has been shaved off. Despite the fact that at least
seven to nine hours of sleep is recommended for the
average individual under 65, and for over 65, an average seven to eight hours, 40 percent of adults report
sleeping less than six hours nightly. Additionally,
between 50 and 70 million adults suffer from some
sort of sleep disorder, with one in three saying they
had trouble falling or staying asleep, according to the
National Sleep Foundation.
To sleep, perchance to dream…
To understand why these numbers concern the medical
community, consider how critical sleep is to human
functioning. Many essential physiological activities
that aid digestion, cell and tissue repair and growth,
muscle growth, protein synthesis and release of
growth hormone occur mostly, or sometimes only,
during sleep. Sleep also regulates the hormones
epinephrine, dopamine and serotonin, which are
closely linked to mood and behavior.
The rejuvenating power of sleep is most evident during
REM (rapid eye movement). This deepest, last, and
most important phase accounts for 25 to 30 percent
of the sleep cycle, when dreaming occurs. At this
point, the learning region of the brain is stimulated,
new neuronal connections are formed and proteins
associated with aging and neural degeneration are
eliminated. For example, one expert theory states the
production of adenosine in brain cells remains high
during wakefulness, but promotes the “drive to sleep.”
Once the body has a chance to clear adenosine from
the system during sleep, we wake feeling rested and
more alert.
What happens when the body is regularly deprived of
life-sustaining sleep? It’s enough to keep you more
awake at night, with research pointing to the potential
for: more frequent colds; irritability; lower quality of life;
elevated blood pressure which can increase the risk of
kidney disease; decreased insulin sensitivity and
glucose tolerance (diabetes); impaired pancreatic
cell responsiveness; calcification of coronary arteries
(heart disease and stroke); mood disorders (anxiety
and depression); and obesity (lower levels of appetitecontrolling hormone, leptin, and higher levels of
ghrelin, which tends to make people ravenous). The
immune system is particularly affected, as production
of proteins needed by the body to fight infections
and inflammation decreases.
Sleep easy
Reassuringly, an extra 15 to 30 minutes of sleep each
Nutrition Corner
Choose This, Not That…
a Smart Eating Series
Healthy eating need not mean deprivation, but simply opting for better choices on the
menu, around the grocery aisles and in your kitchen. In this first of a series, we offer
smart swaps for dining out on today’s favorite ethnic cuisines. We’ll continue with a
look at healthy substitutes for your own table in the next HealthWise.
ORDER THIS
MEXICAN
Gazpacho; Jicama
Vegetable-filled burritos, tamales
Chicken or fish fajitas—marinated
protein grilled with onions, green
peppers, lettuce, diced tomatoes
with a soft corn tortilla
Black or pinto beans, Spanish rice
Tofu, grilled chicken breast, fish or
shrimp fillings
Salsa, pico de gallo, cilantro, low-fat
sour cream, jalapeno peppers
Light Mexican beer, glass of wine
CHINESE
Hot and sour soup, wonton soup
AVOID THAT
Fried tortilla chips
Meat quesadillas—tortilla filled with
meat and cheese and fried
Flautas—crisp tortillas with shredded
meat, sauce
Chimichangas—fried tortillas with meat
and cheese and tomato sauce
Burritos—flour tortillas with beans or
meat, tomato sauce, shredded cheese
Taco salad
Refried beans
Chorizo (sausage), carnitas (pork)
Cheese, sour cream, guacamole
sides, con queso dip
Margaritas
Egg drop soup
Sources: Healthy Dining Finder, AHA, Academy of Nutrition and Dietetics
night can make a significant difference in overall
health and quality of life. Sleep specialists offer
these tips:
n Disconnect. Sixty percent of Americans bring electronic devices along for the night. “We can’t resist the
stimulation,” says Sleepless in America director John
Hoffman. “It’s exceeding anything that we were
designed to experience…it’s keeping us up beyond
what we’re designed for.” Turn off phones, tablets
and TV one hour before sleep time.
n Avoid alcohol before bedtime. Trickier than caffeine,
alcohol typically makes it easier to fall asleep but the
sleep is of poorer quality. Most people will fall asleep
sooner, but spend less time in REM sleep and consequently wake up feeling less refreshed.
n Adjust your bedroom environment by decreasing
light, noise and temperature so that you are comfortable for the night.
n Avoid discussing emotional issues or exercising
right before bed, both of which can cause the body to
secrete the stress hormone cortisol, associated with
alertness.
n Try mindful meditation. Focusing on breathing and
remaining in the present moment was found to improve sleep quality in older adults with moderate sleep
disturbance, according to JAMA Internal Medicine.
n Reset your body clock. Frequent travelers and seniors
are at particular risk for sleeping problems, including
advanced sleep phase syndrome, which causes earlier than normal sleepiness and too-early wake up the
next morning. Using specialized light boxes before bed
or taking melatonin, the “sleep hormone,” have proven
effective in readjusting circadian rhythms.
Still can’t get a good night’s sleep? Please call my
office.
ORDER THIS
CHINESE (cont.)
Vegetable spring rolls, steamed
dumplings, lettuce wraps
Vegetable stir fries: broccoli,
mushrooms, Chinese eggplant,
cabbage, green onions, bean sprouts,
bok choy, snap peas, water chestnuts
Low-sodium soy sauce, sweet and
sour sauce, plum sauce
Steamed brown rice, edamame
ITALIAN
Roasted peppers, minestrone soup
Pasta primavera
Marsala and piccata dishes; grilled
chicken or fish herb-brushed with
extra virgin olive oil
Marsala, marinara, and clam sauces
Pizza with spinach, mushrooms,
broccoli, roasted pepper toppings
GREEK
Hummus with pita
Tzatziki sauce—cucumber and Greek
yogurt
Souvlaki—grilled meat skewers with
Dolmades—grape leaves stuffed with
ground meat and vegetables
Briam—roasted vegetables
Stifado stew—meat and onions in
wine sauce
Lamb or fish with steamed vegetables
AVOID THAT
Fried egg rolls, fried dumplings
Dishes with fried meats, peanuts,
cashews, crispy noodles
Lobster, bean or oyster sauce, regular
soy sauce
Fried rice, lo mein noodles, crab
rangoons
Fried calamari
Fettucini Alfredo
Scallopine or parmigiana dishes—
floured, fried and baked with cheese
Butter or cream sauces, such as
Alfredo
Pizza with pepperoni, sausage, extra
cheese toppings
Saganaki—fried cheese
Skordalia, mashed potatoes and
garlic dip
Gyros sandwiches
Avegolemono—lemony chicken orzo
soup thickened with eggs
Mousaka—vegetables and meat in
cream sauce
Pastitsio—Greek lasagna
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